Individual provider Active NPI

Colleen Klos

  • Internal Medicine Physician
  • Williamsville, NY
National Provider Identifier
1003567603
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
027835-01 Issued in NY
Practice address
1540 Maple Rd
Williamsville, NY 14221-3647
Phone
(716) 568-3514
NPI assigned
Jan 14, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 027835-01 NY Primary

Addresses

Primary practice location

1540 Maple Rd
Williamsville, NY 14221-3647

Mailing address

1540 Maple Rd
Williamsville, NY 14221-3647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220405002860 NY Practitioner - Physician Assistant 6507252285 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Pittsburgh School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

30 N Union Rd
Suite 104
Buffalo, NY 14221-5367
Phone (716) 565-3990

462 Grider St
Buffalo, NY 14215-3021
Phone (716) 898-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
027835-01NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Erie County Medical Center Corporation CurrentSince Jan 9, 2025 Accepting new patients
Erie County Medical Center Corporation CurrentSince Jan 9, 2025 Accepting new patients
Kaleida Health Past Accepting new patients

Locations

100 High St
Buffalo, NY 14203
Phone (716) 632-3700

462 Grider St
Cheektowaga, NY 14215
Phone (716) 831-8612

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1003567603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 MAPLE RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213647",
            "telephone_number": "716-568-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOS",
        "first_name": "COLLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "027835-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.